Eriksson Olle, Bäckström Torbjörn, Stridsberg Mats, Hammarlund-Udenaes Margareta, Naessén Tord
Department of Women's and Children's Health/Obstetrics and Gynecology, University Hospital, Uppsala, Kvinnokliniken, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden.
Psychoneuroendocrinology. 2006 May;31(4):415-27. doi: 10.1016/j.psyneuen.2005.10.004. Epub 2005 Dec 13.
This study tested the hypothesis that brain sensitivity to normal fluctuations in gonadal hormones is increased in women with premenstrual dysphoria. For this purpose, the effect of a common gonadal hormonal challenge on the sensitivity of the brain was investigated in 13 women with premenstrual dysphoria and 12 asymptomatic controls. The estrogen challenge test, comprising estradiolbenzoate 0.04 mg/kg, was given as an intramuscular gluteal injection between 0700 and 1000h on day 3 or 4 of the menstrual cycle; blood was sampled at 0, 0.6, 6.5, 24, 32, 48, 56, 72, 96, 120, and 144h and analyzed for estradiol, FSH and LH. Serum estradiol levels after the injection and the corresponding FSH responses were similar between the study groups; however, the LH responses were significantly different. Women with premenstrual dysphoria had a relatively stronger negative feedback response (p=0.014) up to the point of nadir LH levels (maximal negative feedback), but displayed higher LH levels at the nadir (p=0.01), more LH surge-like reactions (p=0.047), and a 50% higher area under the curve (AUC) for LH (p=0.03) than controls. The LH response in women with premenstrual dysphoria was related to the VAS-rated symptoms; the negative increment (AOC) correlated to luteal phase "bloating" (r(s)=0.73; p=0.0069) whereas the AUC of LH correlated to "irritability" (r(s)=0.58; p=0.040). A significant interaction term between study group and changes in LH during the negative feedback phase (32-0h), with regard to luteal phase "irritability" was found (test for interaction p=0.005). For the premenstrual dysphoria group, ratings of "depressed mood"were related to baseline FSH levels (r(s)=0.60; p=0.034), and to the AUC of FSH during the negative feedback phase (r(s)=0.58; p=0.043). Women with premenstrual dysphoria displayed a gonadotrophin response to estradiol challenge that differed from that of controls, and was correlated to symptom severity.
经前烦躁障碍女性对性腺激素正常波动的脑敏感性增强。为此，在13名经前烦躁障碍女性和12名无症状对照者中，研究了常见性腺激素激发对脑敏感性的影响。雌激素激发试验，包括苯甲酸雌二醇0.04mg/kg，于月经周期第3或4天的07:00至10:00之间进行臀肌内注射；在0、0.6、6.5、24、32、48、56、72、96、120和144小时采集血样，分析雌二醇、促卵泡激素（FSH）和促黄体生成素（LH）。注射后研究组间血清雌二醇水平及相应的FSH反应相似；然而，LH反应显著不同。经前烦躁障碍女性在LH水平最低点（最大负反馈）之前有相对更强的负反馈反应（p=0.014），但在最低点时LH水平更高（p=0.01），有更多的LH峰样反应（p=0.047），且LH曲线下面积（AUC）比对照组高50%（p=0.03）。经前烦躁障碍女性的LH反应与视觉模拟评分法（VAS）评定的症状相关；负增量（AOC）与黄体期“腹胀”相关（r(s)=0.73；p=0.0069），而LH的AUC与“易怒”相关（r(s)=0.58；p=0.040）。发现研究组与负反馈期（32 - 0小时）LH变化之间，关于黄体期“易怒”存在显著的交互项（交互检验p=0.005）。对于经前烦躁障碍组，“情绪低落”评分与基线FSH水平相关（r(s)=0.60；p=0.034），且与负反馈期FSH的AUC相关（r(s)=0.58；p=0.043）。经前烦躁障碍女性对雌二醇激发的促性腺激素反应与对照组不同，且与症状严重程度相关。
